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Chronic hypercapnic COPD — SCE Respiratory MCQ

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HardCOPDChronic hypercapnic COPDSCE Respiratory

A 67-year-old man with severe COPD is reviewed 6 weeks after discharge for acute hypercapnic respiratory failure. Despite optimised inhaled therapy and pulmonary rehabilitation, ABG on air shows pH 7.37, PaCO2 7.4 kPa and PaO2 8.2 kPa. He has morning headaches and two admissions needing NIV in 12 months. What is the most appropriate ventilation strategy?

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Correct answer: A — Specialist assessment for nocturnal home NIV with controlled oxygen if required

Persistent hypercapnia after an episode of acute hypercapnic respiratory failure should prompt specialist home ventilation assessment for nocturnal NIV. Oxygen alone may worsen CO2 retention and does not correct hypoventilation, while CPAP is mainly for obstructive sleep apnoea. A normal pH reflects compensation and does not exclude clinically important chronic ventilatory failure.

Reference: BTS/ICS AHRF Guideline; NICE NG115